- Patient Interactions Related To Diabetes Foot Care

T Institute of Medicine’s re p o rt, Priority Areas for National Action: Tr a n s f o rming Health Care Quality, identified diabetes as a health care a rea in need of improvement (Adams & Corrigan, 2003). Curre n t l y, about 24 million Americans or nearly 8% of the population have diabetes, and another 57 million are at risk for developing the disease (Centers for Disease Control and Prevention [CDC], 2008a). Patients with a primary or co-existing diagnosis of diabetes account for 20% of hospitalizations (Russo & Jiang, 2006), and 7.8% of the home health care population has a p r i m a ry diagnosis of diabetes (National Center for Health Statistics, 2005). F u t u re projections estimate a 198% increase in persons affected with diabetes by 2050 (Venkat Narayan, Boyle, Geiss, Saaddine, & Thompson, 2 0 0 6 ) . H o w e v e r, “despite high quality evidence to aid providers in tre a t i n g diabetes and screening for its complications, the quality of diabetes care remains less than optimal...” (Agency for Healthcare Research and Q u a l i t y, 2004, p. 1). Many patients with diabetes do not receive the established standards of care, especially related to eye and foot scre e n i n g s . A p p roximately 12% of people with diabetes experience a foot ulcer, which is a risk factor for developing further foot problems including lower e x t remity amputations (CDC, 2003). Greater than 60% of nontraumatic lower limb amputations occur in persons with diabetes, which gre a t l y impacts quality of life and contributes to increased health care and disability costs (CDC, 2008b). The CDC (2008b) estimated compre h e n s i v e foot care programs, which include annual exams and self-care strategies, can reduce foot ulcers and amputations by 45%-85%. Because of the ongoing diabetes epidemic and the need for impro v e d d i a b e t e s related outcomes, nurses must be able to interact eff e c t i v e l y with patients with diabetes. Because little is known about this phenomenon, the purpose of this study was to describe re g i s t e red nurse-patient interactions related to diabetic foot care from the RNs’ perspective and c o m p a re interactions across the two practice settings of acute care and home health.